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STUDENT MEDIA RELEASE FORM I hereby Name of Student or Parent/Guardian if Student is under 18 years of age consent to my child/children being filmed audiotaped interviewed videotaped photographed by the media print and broadcast and employees agents or servants of the Halifax Regional School Board on May 24th and May 25th at Beazley Field Location Home Telephone Number Name of School Madeline Symonds Middle School Signature of Student or Parent/Guardian if Student is under 18 years of age Date.

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